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DECLARATION

I/we have Licence No. _____________________________________ hereby confirm that the site whose details are given below is under my/our legal/authorized possession and have clear right to use the same for storage of liquefied Petroleum Gas Cylinders/Petroleum and I/We

further declare that no court case or other legal proceedings are under way in any Court of Law in respect of the said site/land. Details of the site a) Plot No b) Name of the Revenue Village c) Name of Tehsil /Taluka /Mandal d) District : : : :

Signature of the Licence Holder

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